Difficulties in diagnosing of measles inclusion body encephalitis in a child with acute lymphoblastic leukemia

Lytvyn, Halyna; Basa, Natella; Stasiv, Mariia; Troyanovska, O.O.; Dorosh, O.I.

doi:10.1016/j.idcr.2020.e00877

Cited by 6 publications

(4 citation statements)

References 4 publications

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“…[23][24][25][26] Measles as a cause of EPC in immunosuppressed hosts was identified in previous reports by the demonstration of measles inclusion bodies (intranuclear inclusions of paramyxovirus nucleocapsid) by electron microscopy or the presence of measles antigen using fluorescent-labeled antibody probes in the brain and recently using PCR techniques. 27 In our case, the D8 genotype was detected in the brain biopsy and CSF and was consistent with the virus identified during the measles outbreak in the city in November 2022. 28,29 In MIBE, viral replication occurs in the CNS, leading to the intrathecal synthesis of antibodies.…”

Section: Discussionsupporting

confidence: 86%

Epilepsia Partialis Continua as a Sequelae of Measles Infection in Children With Hematolymphoid Malignancies

Sharma,

Dhamne,

Bhosale

et al. 2024

JCO Glob Oncol

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PURPOSE To share our clinical experience with the diagnosis and management of children with hematolymphoid malignancies presenting with epilepsia partialis continua (EPC) as a sequelae of measles infection. MATERIALS AND METHODS In December 2022, a series of children in our hemato-oncology unit presented with focal status epilepticus with no conclusive evidence pointing toward any underlying etiology. One such child had a typical measles rash a few weeks before the onset of this focal status epilepticus. After a series of cases with a similar presentation, a clinical pattern suspicious for measles became evident. cerebrospinal fluid polymerase chain reaction was positive for measles virus with measles immunoglobin M detected in the serum. This led to the diagnosis of measles inclusion-body encephalitis in a series of children who presented with EPC over a period of 3 months. EPC is a rare manifestation of measles that is seen only in immunocompromised patients. RESULTS Among the 18 children reported in this series, only 10 had a history of rashes. The rash was mostly transient and elicited only on retrospective history taking. Five of the 18 children who did not lose consciousness during the prolonged seizure episode survived the disease but had residual neurologic sequelae. Among the 18 children, two were unimmunized and immunization status could not be confirmed in three other children. CONCLUSION This case series highlights the threats posed by measles infection in children with cancer who are immunosuppressed because of the underlying disease and ongoing chemotherapy. Loss of herd immunity because of declining measles immunization rates secondary to vaccine hesitancy and COVID-19 lockdown pose a greater risk of measles infection and its complications for patients with deficient immune systems.

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Section: Discussionsupporting

confidence: 86%

Epilepsia Partialis Continua as a Sequelae of Measles Infection in Children With Hematolymphoid Malignancies

Sharma,

Dhamne,

Bhosale

et al. 2024

JCO Glob Oncol

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“…The recent measles outbreak in Ukraine (2017–2019) showed transformation into MIBE in a child with measles and acute leukaemia. [ 5 ] Pathologically, inclusion bodies have been found to be deposited in the diffuse cerebral cortex, brainstem, paraventricular area and mammillary bodies in MIBE. [ 6 ] The incubation period of SSPE is generally much longer than MIBE.…”

Section: Discussionmentioning

confidence: 99%

Subacute measles encephalitis in a case of late presenting congenital HIV with epilepsia partialis continua as the first manifestation

Chakraborty

Ray

Mukherjee

et al. 2021

Journal of Family Medicine and Primary Care

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We report a case of a 14-year-old non-immunised girl with a prior history of measles infection presenting with afebrile seizures progressing to epilepsia partialis continua (EPC), quadriparesis and headache. Further evaluation revealed Human immunodeficiency virus (HIV) seropositivity with elevated anti-measles antibody titres in Cerebrospinal fluid (CSF). Electroencephalography showed focal epileptiform activity and Magnetic resonance imaging (MRI) of the brain revealed bilateral, asymmetrical long repetition time MRI (TR) hyperintensities involving juxtacortical white matter in both parietal lobes, left temporal and also in the left basal ganglia without any contrast enhancement or Diffusion weighted imaging (DWI) restriction. We describe the intriguing association of EPC with subacute measles encephalitis/measles inclusion body encephalitis (SME/MIBE) in the backdrop of immunocompromised state (HIV seropositivity), thought to have been acquired by vertical transmission. Also, prolonged asymptomatic HIV infection, first unmasked by measles infection, followed by rapidly deteriorating neurological illness makes this index case worthy to be reported.

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“…This includes general examination of the skin, mucous membranes, lymph nodes, and central nervous system [ 21 ]. Some specific findings include positive Kernig’s sign, nuchal rigidity, involuntary movement of muscles [ 22 ], low Glasgow Coma Scale (GCS) score, visual defects on ophthalmology, dysarthria, general hypotonia, depressed reflexes [ 23 ], photophobia, and speech disturbances [ 24 ].…”

Section: Managementmentioning

confidence: 99%

Measles Induced Encephalitis: Recent Interventions to Overcome the Obstacles Encountered in the Management Amidst the COVID-19 Pandemic

et al. 2022

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Encephalitis, a well-known complication of measles, is inflammation of the brain parenchyma which is mostly due to the viral invasion of neurons. It presents with a variety of symptoms ranging from mild to severe depending on the extent of the damaged neurons. The diagnosis is based on clinical symptoms such as fever, headache, altered level of consciousness, focal neurological deficits, etc. A detailed history and physical examination facilitate the diagnosis. Investigations include blood tests for measles-specific antibodies, CT, MRI, and analysis of the CSF. The management of measles-induced encephalitis mainly revolves around prevention against contracting the disease and providing supportive care if acquired. The administration of the measles vaccine is the major means of preventing this disease in childhood. Two doses are required to achieve sufficient immunity against measles, the first at the age of 12–15 months and the second at 4–6 years of age. Supportive care includes administering acetaminophen for fever, oral rehydrating salt (ORS) for diarrhea and vomiting, antibiotics for otitis media and pneumonia, and using anti-epileptics such as sodium valproate for seizures. Vitamin A can be given to prevent severe effects in children. The specific treatment would depend on the type of encephalitis the patient has developed.

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Difficulties in diagnosing of measles inclusion body encephalitis in a child with acute lymphoblastic leukemia

Cited by 6 publications

References 4 publications

Epilepsia Partialis Continua as a Sequelae of Measles Infection in Children With Hematolymphoid Malignancies

Epilepsia Partialis Continua as a Sequelae of Measles Infection in Children With Hematolymphoid Malignancies

Subacute measles encephalitis in a case of late presenting congenital HIV with epilepsia partialis continua as the first manifestation

Measles Induced Encephalitis: Recent Interventions to Overcome the Obstacles Encountered in the Management Amidst the COVID-19 Pandemic

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